S219: PREDICTING THROMBOTIC RISK IN PATIENTS WITH HODGKIN LYMPHOMA: A MULTICENTRIC STUDY OF THROLY AND KHORANA RISK SCORES
Authors: Giovanni Manfredi Assanto, Martina Salvatori, Sara Pontecorvo, Gianluca Maiorana, Natalia Cenfra, Gianna Maria D’elia, Maria Paola Bianchi, Giorgia Annechini, Cristina Santoro Santoro, Maurizio Martelli, Agostino Tafuri, Alessandro Pulsoni, Ilaria Del Giudice, Antonio Chistolini
Journal: HemaSphere (2023)

Background: Thrombosis Lymphoma (ThroLy) and Khorana scores have been conceived to predict the basal thrombotic risk in patients with lymphoma and cancer, respectively. Currently, there are no univocal indications on the thrombosis prophylaxis in patients with Hodgkin lymphoma (HL), that is mostly guided by clinical judgement. Aims: To validate the ThroLy and Khorana scores and to identify other potential risk factors for thrombotic events (TE) in HL patients. Methods: Consecutive patients with newly diagnosed HL from 2018 to 2020 were included in a retrospective multicentric study. Statistical analysis was performed with univariate (χ2-test; Kaplan-Meier curve) and multivariate analysis (COX-regression model). Results: A total of 191 HL patients who did not receive thrombosis prophylaxis were included. The median follow-up was 28 months (range 6-57). According to Khorana criteria, intermediate risk patients were 80.1% (n=153), high-risk 19.9% (n=38). According to ThroLy score, low-risk patients were 36.6% (n=70), intermediate-risk 47.6% (n=91) and high-risk 15.7% (n=30). Twenty-five patients experienced a TE (13.2%) after 3 months from diagnosis (range 1-17). A significant association was found between ThroLy score and thrombotic risk: TE were observed in 30% (9/30) of high-risk patients, 12.1% (11/91) and 7.4% (5/68) of intermediate and low-risk cases, respectively (p 0.003). Each single risk factor included in the ThroLy score was analyzed. Extranodal disease had a significant association with TE: 23% (17/74) vs 6.8% (8/117) for patients who had no extranodal involvement (p 0.002). Mediastinal involvement (bulky or not bulky) was confirmed as a significant prognostic factor: 19% (15/79) of patients developed TE vs 8.9% (10/112) of patients without mediastinal involvement (p 0.036). Patients with ECOG performance status (PS) 2-4 presented the highest rate of events, 46.7% (7/15) vs 10.2% (18/176) for patients ECOG 0-1 (p 0.002). Conversely, anemia, BMI and neutropenia at diagnosis were not confirmed as prognostic factors in univariate analysis. No patient had previous venous thrombosis/acute myocardial infarction/stroke. Patients with bulky disease at diagnosis, independently of the anatomic site, showed 30% thrombotic rate (9/30) vs 10% for patients without bulky disease (16/161) (p 0.001). In a multivariate analysis including ThroLy score and other significant risk factors, we confirmed the independent prognostic impact on TE risk of bulky disease (regardless of the anatomical site) (Hazard Ratio, HR 2.88), extranodal involvement (2.74), mediastinal involvement (HR 2.11) and ECOG PS 2-4 (HR 5.08). On the base of these 4 significant risk factors, we proposed a new risk model (called HL-ThroLy): low-risk was defined by the absence of any risk factor, intermediate-risk by the presence of 1 and high-risk by the presence of more than 1 risk factor. High-risk patients had 29% of TE (16/56), intermediate-risk 9.3% (7/73) and low-risk 3.3% (2/60) (p 0.00001, Figure 1). Comparing conventional ThroLy and HL-ThroLy, the latter proved to be an independent predictor of TE (HR 3.17, range 1.7-5.9, p <0.00001). Summary/Conclusion: Our findings show that ThroLy score is able to predict thrombotic risk in HL patients. We propose a highly feasible and disease-specific HL-Throly score, that includes 4 patient-related parameters which are easily assessable by the physician in the daily routine. If validated in a prospective trial, HL-Throly could be a useful tool to determine which patients could benefit the most from primary prophylaxis from diagnosis.Figure 1 Keywords: Thromboembolism, Hodgkin’s lymphoma, Hemostasis, Thromboembolic events